The extended genitourinary examination is an easily administered addition to the assessment of men and women during evaluation for UCPPS. Physical findings may help to better categorize patients with UCPPS into clinically relevant subgroups for optimal treatment.

Left ventricular mass (LVM) has been shown to to serve as measure of target organ damage resulting from chronic exposure to several risk factors. Data on the association of mid-life LVM with later cognitive performance are sparse. We studied 721 adults (mean age 56 years at baseline) enrolled in the Strong Heart Study (SHS, 1993–1995) and the ancillary Cerebrovascular Disease and its Consequences in American Indians Study (CDCAI, 2010–13), a study population with high prevalence of cardiovascular disease (CVD). LVM was assessed with transthoracic echocardiography at baseline in 1993 to 1995. Cranial magnetic resonance imaging (MRI) and cognitive testing were undertaken between 2010 and 2013. Generalized estimating equations were used to model associations between LVM and later imaging and cognition outcomes. The mean follow-up period was 17 years. A difference of 25 gm in higher LVM was associated with marginally lower hippocampal volume (0.01 %; 95% CI 0.02, 0.00; p-value 0.001) and higher white matter grade (0.10; 95% CI 0.02, 0.18; p-value 0.014). Functionally, participants with higher LVM tended to have slightly lower scores on the modified mini-mental state examination (3MSE) (0.58; 95% CI 1.08, 0.08; p-value 0.024). The main results persisted after adjusting for blood pressure levels or vascular disease. The small overall effect sizes are partly explained by survival bias due to the high prevalence of cardiovascular disease in our population. Our findings emphasize the role of cardiovascular health in mid-life as a target for the prevention of deleterious cognitive and functional outcomes in later life.

BackgroundAccording to the Risk Perception Attitude (RPA) framework, classifying people according to their perceptions of disease risk and their self-efficacy beliefs allows us to predict their likelihood for engaging in preventive behaviors. Health interventions can then be targeted according to RPA group. We applied the framework to type 2 diabetes prevention behaviors among American Indians and expanded it to include culture and numeracy.MethodsUsing a cross-sectional study design, we surveyed a sample of Northern Plains American Indians in a reservation community setting on self-reported perceptions of diabetes risk, objective diabetes risk, self-efficacy, engagement in healthy behaviors, knowledge of diabetes risk factors, and covariates including demographics, numeracy, and cultural identity. We used the RPA framework to classify participants into four groups based on their perceptions of risk and self-efficacy. Analyses of variance and covariance estimated inter-group differences in behaviors associated with type 2 diabetes prevention.ResultsAmong 128 participants, our only finding consistent with the RPA framework was that self-efficacy and risk perception predicted knowledge about diabetes risk factors. We found limited evidence for the influence of cultural identity within the RPA framework. Overall, participants had lower numeracy skills which tended to be associated with inaccurate perceptions of higher levels of risk.ConclusionsThe theoretical framework may benefit from inclusion of further contextual factors that influence these behaviors. Attention to numeracy skills stands out in our study as an important influence on the RPA framework, highlighting the importance of attending to numeracy when targeting and tailoring risk information to participants segmented by the RPA framework.